Three biologics have been approved by the Food and Drug Administration (FDA) for patients with chronic rhinosinusitis with nasal polyps: dupilumab, mepolizumab, and omalizumab. Among them, dupilumab was the first to obtain a regulatory approval for this patient population, and, reportedly, has been the most prescribed. Typically, dupilumab is reserved for patients with chronic rhinosinusitis with nasal polyps who have not responded to treatment with a sinus surgery in combination with medical therapy, including intranasal and oral corticosteroids. However, in a smaller population of patients who cannot safely undergo a sinus surgery, dupilumab can be used as a primary therapy.
Several reports have indicated increased dupilumab use as a first-line therapy among patients with chronic rhinosinusitis with nasal polyps, and especially in those who have been cared for by healthcare providers from non-surgical specialties. However, dupilumab practice patterns should be evaluated systematically in large patient cohorts.
In his presentation at the 2024 American Rhinologic Society (ARS) meeting at the COSM, held on May 15–16, 2024 in Chicago, Daniel Xiao reported data from a study from UTHealth Houston that analyzed trends in dupilumab use in a large cohort of patients with chronic rhinosinusitis with nasal polyps.
In the presented study, the investigators searched Epic’s Cosmos database to identify patients with chronic rhinosinusitis with nasal polyps. They selected the rapidly expanding Epic’s Cosmos Database, because it contains deidentified patient information contributed by thousands of clinics and hospitals across the United States and encompasses hundreds of millions of patients and billions of patient encounters. The researchers in this study identified 1,808,599 patients with chronic rhinosinusitis with nasal polyps seen between May 2020 and April 2023. Next, they checked whether the patients included in the study had an active dupilumab prescription and/or a prior sinus surgery, and what physician specialty (including an ENT, a pulmonologist, or an allergist) was present during each patient encounter.
The percentage of encounters with patients who had been prescribed dupilumab increased during the analyzed 3-year period at a rate of 0.01% per month (p < 0.01). At the same time, the percentage of patients who had undergone an endoscopic sinus surgery during the 12 months preceding dupilumab initiation decreased significantly. An analysis, stratified by the specialty of the healthcare provider present at each patient encounter, was also performed. It showed that the percentage of encounters with patients with an active dupilumab prescription increased at a higher rate for allergists (0.21% per month, p < 0.001) than for pulmonologists (0.06% per month, p = 0.026) or ENTs (0.03% per month, p = 0.006).
A limitation of the current investigation is the fact that it could only confirm the presence of an active dupilumab prescription during a patient encounter, but could not determine which specific physician had prescribed dupilumab.
The researchers found that, over the analyzed 3-year period, the encounters with patients with chronic rhinosinusitis with nasal polyps with an active dupilumab prescription increased. This rise in dupilumab use in patients with chronic rhinosinusitis with nasal polyps can likely be attributed to an elevated prescription rate.
Although ENTs managed most patients with chronic rhinosinusitis with nasal polyps included in the study, higher rates of encounters with patients with an active dupilumab prescription were observed for physicians with a non-surgical specialty. In addition, fewer patients were receiving a recommend endoscopic sinus surgery 12 months prior to initiating dupilumab. Altogether, the results of the study suggest that dupilumab may increasingly be used as a first-line therapy for chronic rhinosinusitis with nasal polyps. However, future studies analyzing prescriber data should be performed to confirm and expand these findings.
The authors of this study included Daniel Xiao; Martin Citardi, MD, FARS; Amber Luong, MD, PhD, FARS; William Yao, MD, FARS; and Jason Talmadge, MD, FARS